Movable prosthetic pieces are mentioned for the first time by this author. Although he is very concise in his manner of speaking of artificial teeth (this indicating that dental prosthesis was considered outside the sphere of action of the general surgeon), we nevertheless learn from him that partial sets of teeth made of ivory or hippopotamus tusks, and without special appliances for fixing them, were then in use, which, when applied in the void between the neighboring teeth, were maintained in position simply by their form. The author advises keeping prosthetic pieces very clean, removing them every evening before going to bed, and not putting them back in the mouth until they have been well cleaned.
Heister also speaks of nasal prosthesis; this was then carried out by applying noses made of wood or of silver, properly painted. In cases of trismus, this author altogether rejects the forcible opening of the jaws by means of screw dilators and such like instruments, as they act too violently, and, according to him, only aggravate the morbid condition. Even the extraction of a tooth is useless in such cases, as the patient can always absorb a certain quantity of liquid food through the closed teeth. On the other hand, the author expresses himself in favor of the incision of the gums in cases of difficult dentition. According to him, convulsions and the other nervous symptoms which children are subject to during the period of dentition depend wholly on the hardness and strained condition of the gum. It is, therefore, natural that the symptoms should disappear when an incision of the gums, reaching to the tooth that is coming through, has caused the tension to cease.
The author speaks very particularly of the treatment of epulis and parulis; but his views on this subject contain nothing of great importance.
René Jacques Croissant de Garengeot (1688 to 1759), the celebrated French surgeon, speaks very little of dental surgery in his works. He declares himself averse to the carrying out of too many operations on the teeth, and especially disapproves the use of the file, because, according to him, it ruins the enamel.[400] For a long time, especially in France, Garengeot was believed to have been the inventor of the key known by his name; but he merely perfected this instrument. In fact, through a later author, Lecluse, it clearly results that the key existed before Garengeot. “For extracting,” writes Lecluse, “one may make use of the pelican that Garengeot has constructed on the English key.” In a note, he afterward adds, “that the English key is an instrument used by dentists in England.” However, it is not in the least certain that the key is really an instrument of English origin.
Loder, who wrote at the end of the eighteenth century, informs us that the so-called English key was called the German key in England; it is, therefore, not improbable, that this instrument, as some maintain, had its origin in Germany.[401]
Johann Junker (1679 to 1759), professor of medicine at the University of Halle, wrote on dental maladies, not only in a treatise on surgery, published in 1721, but also in three dissertations which were published some time later, and were entitled respectively: De affectibus dentium (1740), De dentitione difficili (1745), De odontalgia (1746). The author, however, for the most part, only repeats things already known; his writings have, therefore, little or no importance for us. He counsels the Cowper-Drake operation in treating the affections of Highmore’s antrum; in carrying out the operation, however, he thinks the extraction of the second molar to be preferable to that of the first. To prevent the formation of tartar on the teeth, he advises assiduous care in keeping the mouth clean, and recommends, among other things, rubbing the teeth with sage. He disapproves having recourse too readily to metal instruments to remove tartar from the teeth, because, according to him, it favors the production of dental caries. He holds it dangerous to extract the upper or lower canines when they are not loose, as, by reason of the depth of their roots an injury to the surrounding nerves may be the result, which not only might cause great pain, but in the case of the upper canines might lead to inflammation of the eye, and even of the dura mater!
When the caries is incipient, Junker advises rubbing the teeth several times a day for some time with common salt, in order that this should penetrate into their structure.[402]
Guillaume Maquest de la Motte (1655 to 1737), a distinguished French surgeon and the writer of an excellent treatise (Traité complet de chirurgie, Paris, 1722), repeats the advice already given by preceding authors, to which he annexes the highest importance, that is, the opening in time of abscesses of the gums and of the palate even before they be completely matured, in order to prevent the suppurative process from extending and damaging the bone below. This author relates having several times arrested serious hemorrhage following on the extraction of teeth, by applying a little vitriol inside the alveolus, and, on this, graduated compresses, which the patient pressed on the part with the teeth of the opposite jaw.[403]
Johann Adolph Göritz, of Regensburg, in one of his writings published in 1725, disapproves the too frequent recurrence to extraction of the teeth, that is, carrying out the operation when it is not absolutely necessary. He is also averse to the application of artificial teeth. In support of his opinion he relates a case in which, a certain time after the application of an artificial tooth, the natural ones to which it had been fixed became loose, so that it was necessary to proceed to the fixing of all three, that is, the artificial tooth and the two neighboring ones, to the firm teeth beyond them; these, however, became loosened in their turn, and it was at last necessary to extract six teeth. The great space thus created was filled with a prosthetic piece made of hippopotamus tusk; but the author did not believe much good would come of this either. In fact, he is of opinion that the natural teeth should be preserved by every possible means, and that, on the other hand, even in the case of a few being lost, it is better not to resort to substitutes. In the worst case, should the dental void cause too great inconvenience by damaging the pronunciation, or for some other reason, it may be filled by an “imitation” in soft wood.[404]
